Menopause

Perimenopause- Postmenopause

Menopause is time in a woman's life when her periods (menstruation) eventually stop and the body goes through changes that no longer allow her to get pregnant. It is a natural event that normally occurs in women age 45 - 55.

Causes, incidence, and risk factors

During menopause, a woman's ovaries stop making eggs and they produce less estrogen and progesterone. Changes in these hormones cause menopause symptoms. Periods occur less often and eventually stop. Sometimes this happens suddenly. But most of the time, periods slowly stop over time.

Menopause is complete when you have not had a period for 1 year. This is called postmenopause. Women who are post-menopausal can no longer get pregnant.

Surgical menopause is when medical treatments cause a drop in estrogen. This can happen if your ovaries are removed, or if you receive chemotherapy or hormone therapy for breast cancer.

Symptoms

Symptoms vary from woman to woman. They may last 5 or more years. Some women may have worse symptoms than others. Symptoms of surgical menopause can be more severe and start more suddenly.

The first thing you may notice is that your periods start to change. They might occur more often or less often. Some women might get their period every 3 weeks. This might last for 1-3 years before the periods completely stop.

Signs and tests

Blood and urine tests can be used to look for changes in hormone levels. Test results can help your doctor determine if you are close to menopause or if you have already gone through menopause.

Tests that may be done include:

Estradiol

FSH

LH

Your health care provider will perform a pelvic exam. Decreased estrogen can cause changes in the lining of the vagina.

Bone loss increases during the first few years after your last period. Your doctor may order a bone density test to look for bone loss related to osteoporosis.

Treatment

Treatment for menopause depends on many things, including how bad your symptoms are, your overall health, and your preference. It may include lifestyle changes or hormone therapy.

HORMONE THERAPY

Hormone therapy may help if you have severe hot flashes, night sweats, mood issues, or vaginal dryness. Hormone therapy is treatment with estrogen and, sometimes, progesterone.

Talk to your doctor about the benefits and risks of hormone therapy. Your doctor should be aware of your entire medical history before prescribing hormone therapy (HT). Learn about options that do not involve taking hormones.

Several major studies have questioned the health benefits and risks of hormone therapy, including the risk of developing breast cancer, heart attacks, strokes, and blood clots.

Current guidelines support the use of HT for the treatment of hot flashes. Specific recommendations:

HT may be started in women who have recently entered menopause.

HT should not be used in women who started menopause many years ago, except for estrogen vaginal creams.

A lower dose of estrogen or a different estrogen preparation (for instance, a vaginal cream or skin patch rather than a pill)

Frequent and regular pelvic exams and Pap smears to detect problems as early as possible

Frequent and regular physical exams, including breast exams and mammograms

If you have a uterus and decide to take estrogen, you should also take progesterone to prevent cancer of the lining of the uterus (endometrial cancer). If you do not have a uterus, you do not need progesterone.

See also: Hormone therapy

ALTERNATIVES TO HORMONE THERAPY

There are other medicines available to help with mood swings, hot flashes, and other symptoms. These include:

Complications

Some women have vaginal bleeding after menopause. This is often nothing to worry about. However, you should tell your health care provider if this occurs. It may be an early sign of other health problems, including cancer.

Decreased estrogen levels have been linked with some long-term effects, including:

Bone loss and osteoporosis in some women

Changes in cholesterol levels and greater risk of heart disease

Calling your health care provider

Call your health care provider if:

You are spotting blood between periods

You have had 12 consecutive months with no period and suddenly vaginal bleeding or spotting begins again, even if it is a very small amount

Prevention

Menopause is a natural and expected part of a woman's development and does not need to be prevented. You can reduce your risk of long-term problems such as osteoporosis and heart disease by taking the following steps:

Control your blood pressure, cholesterol, and other risk factors for heart disease.